EP2337532A1 - Device for the treatment of biological tissue using laser radiation - Google Patents

Device for the treatment of biological tissue using laser radiation

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Publication number
EP2337532A1
EP2337532A1 EP09778438A EP09778438A EP2337532A1 EP 2337532 A1 EP2337532 A1 EP 2337532A1 EP 09778438 A EP09778438 A EP 09778438A EP 09778438 A EP09778438 A EP 09778438A EP 2337532 A1 EP2337532 A1 EP 2337532A1
Authority
EP
European Patent Office
Prior art keywords
treatment
radiation
time interval
tissue
target tissue
Prior art date
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Granted
Application number
EP09778438A
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German (de)
French (fr)
Other versions
EP2337532B1 (en
Inventor
Ralf Brinkmann
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Medizinisches Laserzentrum Luebeck GmbH
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Medizinisches Laserzentrum Luebeck GmbH
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Publication of EP2337532A1 publication Critical patent/EP2337532A1/en
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0093—Detecting, measuring or recording by applying one single type of energy and measuring its conversion into another type of energy
    • A61B5/0095—Detecting, measuring or recording by applying one single type of energy and measuring its conversion into another type of energy by applying light and detecting acoustic waves, i.e. photoacoustic measurements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
    • A61B2017/0011—Sensing or detecting at the treatment site ultrasonic piezoelectric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00115—Electrical control of surgical instruments with audible or visual output
    • A61B2017/00128—Electrical control of surgical instruments with audible or visual output related to intensity or progress of surgical action
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00863—Retina

Definitions

  • the invention relates to a device for the treatment of biological tissue, in particular living tissue with laser radiation.
  • the treatment lasers used in photocoagulation are mainly lasers whose pulsed treatment radiation is in the green wavelength range. This radiation is particularly strongly absorbed in the fundus layers of the eye.
  • solid-state lasers for example the frequency-doubled Nd: YAG with a wavelength of 532 nm are used.
  • Argon ion lasers with 514 nm are also frequently used.
  • the laser beams used here produce spot sizes of 50 to 500 ⁇ m in the target tissue.
  • the laser powers can be up to several hundred mW, with radiation durations of 50 ms to 500 ms being used.
  • panretinal photocoagulation is used with the macular recess, in which treatment is carried out over a large area with a few hundred to over one thousand coagulation spots. Furthermore, photocoagulation is used in retinal holes and retinal detachments. In this case, a connection of the retina to the substrate is made in the marginal areas of the retinal damage by scar formation.
  • EP 1 279 385 A1 discloses the temperature determination in the treatment of biological tissue, in particular on the ocular fundus, by means of laser radiation. During the respective pulses of the pulse-shaped treatment radiation, additional radiation pulses having a shorter pulse duration and lower energy than the treatment radiation are directed onto the target tissue. Resulting tissue expansions and tissue contractions produce bipolar pressure waves, which are detected. From these measured pressure transients, the corresponding temperature values during the irradiation are determined with the aid of the Grüneisen calibration curve and a calibration temperature.
  • the object of the invention is to provide a device of the type mentioned, in which the control of the treatment radiation is improved.
  • the device includes a device for generating a pulsed treatment radiation, preferably a laser radiation, to be directed to a target tissue.
  • a detector device is provided for detecting pressure amplitudes emanating from the target tissue. These pressure amplitudes may be induced by the treatment radiation, in which case the treatment radiation has a frequency of at least 100 Hz.
  • the detector device is for detecting the pressure amplitudes induced by the measuring radiation and originating from the target tissue suitable.
  • an evaluation device is provided for evaluating the pressure amplitudes detected by the detector device and a control device for controlling the treatment radiation as a function of the evaluated pressure amplitudes.
  • no tissue change takes place during a first heating time interval At 1 in the target tissue.
  • the duration of this first time interval may be, for example, 20-50 ms.
  • During the treatment with the treatment radiation is preferably irradiated with additional pulsed laser radiation, as is known from EP 1 279 385 A1.
  • the resulting pressure amplitudes increase with time t during the interval At 1 on average according to a function f (t).
  • the function m (t) represents the fundamental curvature behavior of the time course of the mean pressure amplitudes during the heating phase of the tissue in the absence of tissue changes.
  • the function m (t) is known (Jochen Kandul-Ia, Ralf Brinkmann, "Non-invasive real-time temperature determination during laser treatments on the retina of the eye”: Photonic 2/2007, 42-46), which is based on the error function It can be well approximated over short time intervals with various simpler functions
  • the function m (t) can be stored in a memory of the evaluation device or a memory which is connected to the evaluation device.
  • the fit factor a depends on the sample laser energy and pigmentation of the area just irradiated, but also on the sound propagation in the eye, the acoustic impedance jump on the cornea, the transducer geometry and sensitivity, the signal amplification, etc.
  • a function a * m (t) is also available in a time interval At 2 following the first time interval.
  • the evaluation device is designed such that it determines whether and when in the second time interval ⁇ t 2 following the first time interval a certain predetermined deviation V * of the current one
  • the control circuit which serves to control the treatment radiation, can be designed to control the duration and / or the power of the respective pulse of the treatment radiation.
  • the duration of ⁇ t 3 is determined by the time t, or by the duration of ⁇ t 2 , where z B the duration of ⁇ t 3 can be selected in proportion to the duration of At 2
  • ⁇ t 2 the shorter is ⁇ t 3
  • the evaluation device is preferably designed as a computer-aided evaluation device which contains corresponding memories for the function m (t) and the experimentally determined data required for the control of the treatment radiation, in particular in the third time interval. This may be data relating to the still-to-be-processed time and The invention makes it possible to use the measured pressure transients for the control of the treatment radiation. In particular, no calibration or calibration to a temperature or other reference values is necessary
  • Figure 1 shows an embodiment of the device according to the invention.
  • Figure 2 is a graph illustrating the operation of the embodiment shown in Figure 1;
  • FIG. 1 shows a schematic block diagram of an embodiment of the treatment device.
  • This includes a treatment laser device 1 which has a treatment laser which emits a pulsed treatment radiation in the green wavelength range, for example with a wavelength of 532 nm.
  • a frequency doubled Nd: YAG laser can be used.
  • An argon-ion laser emitting pulsed treatment radiation with a wavelength of 514 nm is also suitable.
  • the spot sizes for the treatment beam impinging on the target tissue may be from 10 ⁇ m to 1000 ⁇ m.
  • the irradiation times for each radiation pulse may be from 30 ms to 500 ms or even higher.
  • the laser power will be selected from 30 mW to over 1000 mW, depending on the treatment to be performed.
  • the illustrated apparatus further includes two measuring laser devices 2 and 3.
  • the measuring laser device 2 includes a measuring laser which emits pulsed measuring laser radiation in the green wavelength range, for example with a wavelength of 532 nm. This measurement laser radiation is coupled into the beam path of the treatment laser radiation by means of an optical coupler 7.
  • the second measuring laser device 3 includes a measuring laser which emits pulsed measuring radiation in the infrared range, for example with a wavelength of 1064 nm.
  • the measuring radiation is coupled by means of an optical coupler 8 in the beam path of the treatment radiation.
  • the pulse energy of the two measuring lasers is significantly lower than that of the treatment radiation and is typically a few ⁇ J.
  • the pulse durations are also at least a hundred times lower than the treatment radiation.
  • the two measuring radiations of the measuring laser devices 2 and 3 are coupled into the treatment beam path coming from a light guide 10 from the treatment laser device 1 by means of the optical couplers 7 and 8.
  • the treatment radiation and the measurement radiation are conducted via a common light guide 10 into a slit lamp optics 9 and directed from there to the fundus, for example the retina of an eye 11.
  • the fundus for example the retina of an eye 11.
  • it is achieved that the treatment radiation and the two measuring radiation impinge on the target tissue of the retina in the same spot.
  • the pressure waves induced by the two measuring radiations are detected and measured by a detector 4.
  • the detector 4 is placed on the cornea by means of a contact lens.
  • EP 1 279 385 A1 describes various detector arrangements which can be used.
  • only one measuring laser device can be used. It is also possible to use more than two measuring laser devices.
  • the frequency of the treatment radiation is chosen so that evaluable pressure amplitudes are detected by the detector device 4.
  • the frequency of the treatment radiation in this case is at least 100 Hz.
  • the pressure amplitudes induced by this radiation on the target tissue are then detected by the detector device 4 for the evaluation.
  • the pressure amplitudes (pressure transients) measured by the detector device 4 are fed to an evaluation device 5 and, as will be explained, evaluated. Depending on the evaluation, the control of the treatment laser device, in particular of the treatment laser, then takes place by means of a control device 6.
  • Both the evaluation device 5 and the control device 6 work computer-aided and can be implemented in an electronic computer device 15.
  • the curves of the pressure amplitudes induced by the two measuring radiations are plotted over the time t in seconds (s). Both for the pressure transients induced in the green wavelength range and for the pressure transients induced in the infrared wavelength range, an increase in the pressure amplitudes due to the temperature dependence of the thermoelastic expansion results at constant pulse energy of the respective measuring laser or treatment laser.
  • a treatment laser power which triggers a tissue coagulation for example a laser power of 180 mW
  • a substantially identical increase in pressure occurs within a first time interval At 1 in which no photocoagulation takes place both induced pressure transients 13 and 14.
  • the pressure transients 13 are the green induced pressure transients and the pressure transients 14 are the infrared induced pressure transients.
  • the course of the green-induced pressure amplitudes shows a flattening, while the infrared-induced pressure amplitudes continue to increase.
  • the different course of the two pressure curves results from the fact that the infrared measuring radiation penetrates deeper into the fundus layer than the green measuring radiation.
  • the scattering increases with onset of coagulation in the retina and the RPE, which reduces absorption in the target tissue. In the infrared, this effect also occurs, but is weaker due to the higher wavelength. However, it is overcompensated by the overall increased absorption in the choroid by the reduced mean free path of a photon.
  • the incipient photocoagulation of the tissue leads to pressure changes and deviations from the expected pressure curve without phase transition.
  • This behavior is exploited according to the invention by fitting a function a * m (t) with the simplest possible algorithm to the currently measured pressure profile of the measured data during the first time interval ⁇ ti.
  • Curve 12 represents this function, which is used to control the treatment radiation.
  • the first time interval At 1 is chosen to be so small that it is certain that no changes in the irradiated tissue occur. This time interval may be, for example, 20-50 ms.
  • f (t) a * m (t).
  • complex imaging algorithms can also be used.
  • the course of the current measurement data function f (t) and of a * m (t) are determined during the treatment radiation on a respective target tissue.
  • the third time interval ⁇ t 3 which begins at the time t, it is possible to resort to tabulated data which have been previously determined experimentally. These are, in particular, data for calculating the duration of the third time interval ⁇ t 3 and, if appropriate, data for changing the power of the treatment radiation for a preselected coagulation intensity.
  • the duration of the irradiation in the third time interval is proportional to the duration of the second time interval .DELTA.t 2 or proportional to the time t selected.
  • the function m (t) used in the fit condition can be stored in the memory of the computer 15.
  • the function m (t) is based on the fact that the increase in the pressure amplitude as a function of the temperature at the irradiation location can be described in good nutrition with a second-degree polynomial.
  • the temporal development of the temperature increase as a result of the treatment irradiation is again theoretically derived from the error function as a solution of the heat diffusion equation. (Jochen Kandulla, Ralf Brinkmann, "Non-invasive real-time temperature determination during laser treatment of the retina of the eye”: Photonic 2/2007, 42-46).

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Abstract

The invention relates to a device for the treatment of biological, particularly living tissue, comprising a laser treatment unit (1) for generating pulsed treatment radiation directed toward a target tissue, and in one embodiment comprising a measuring laser device (2, 3) for generating pulsed measurement radiation directed toward a target tissue at a lower energy level and a lower pulse duration than the treatment radiation, a detector unit (4) for measuring pressure transients induced by the measurement radiation, and a controller (6) for controlling the treatment radiation as a function of the pressure transient analyzed relative to a tissue change, wherein a regulating or control algorithm is generated for controlling the treatment radiation.

Description

Vorrichtung zur Behandlung von biologischem Gewebe mit Laserstrahlung Device for the treatment of biological tissue with laser radiation
Die Erfindung betrifft eine Vorrichtung zur Behandlung von biologischem Gewebe, insbesondere lebendem Gewebe mit Laserstrahlung.The invention relates to a device for the treatment of biological tissue, in particular living tissue with laser radiation.
Bekannt ist die therapeutische Laseranwendung am Augenhintergrund, insbesondere bei Netzhauterkrankungen, zur Erzielung von Photokoagulation an der Netzhaut. Als Be- handlungslaser bei der Photokoagulation kommen hauptsächlich Laser zum Einsatz, deren gepulste Behandlungsstrahlung im grünen Wellenlängenbereich liegt. Diese Strahlung wird in den Fundusschichten des Auges besonders stark absorbiert. Häufig werden Festkörperlaser, beispielsweise der frequenzverdoppelte Nd: YAG mit einer Wellenlänge von 532 nm verwendet. Auch Argon-Ionen-Laser mit 514 nm kommen häufig zur Anwen- düng. Die dabei zum Einsatz kommenden Laserstrahlen erzeugen Spotgrößen von 50 bis 500 μm im Zielgewebe. Die Laserleistungen können bis zu mehreren hundert mW betragen, wobei Bestrahlungsdauern von 50 ms bis 500 ms zum Einsatz kommen. Bei diabetischer Retinopathie wird mit Aussparung der Makula panretinale Photokoagulation eingesetzt, bei welcher großflächig mit einigen hundert bis zu über tausend Koagulationsspots die Behandlung durchgeführt wird. Ferner wird die Photokoagulation bei Netzhautlöchern und Netzhautabhebungen verwendet. Hierbei wird in den Randgebieten der Netzhautschäden durch Narbenbildung eine Verbindung der Retina mit dem Untergrund hergestellt.Therapeutic laser application to the ocular fundus, especially in retinal diseases, is known for achieving photocoagulation on the retina. The treatment lasers used in photocoagulation are mainly lasers whose pulsed treatment radiation is in the green wavelength range. This radiation is particularly strongly absorbed in the fundus layers of the eye. Frequently, solid-state lasers, for example the frequency-doubled Nd: YAG with a wavelength of 532 nm are used. Argon ion lasers with 514 nm are also frequently used. The laser beams used here produce spot sizes of 50 to 500 μm in the target tissue. The laser powers can be up to several hundred mW, with radiation durations of 50 ms to 500 ms being used. In diabetic retinopathy panretinal photocoagulation is used with the macular recess, in which treatment is carried out over a large area with a few hundred to over one thousand coagulation spots. Furthermore, photocoagulation is used in retinal holes and retinal detachments. In this case, a connection of the retina to the substrate is made in the marginal areas of the retinal damage by scar formation.
Für die Dosierung werden bislang die Behandlungsparameter nach Erfahrungswerten eingestellt. Aufgrund unterschiedlicher Pigmentierungen im Auge können die bei der Photokoagulation erzeugten Temperaturen jedoch mehr oder weniger stark schwanken. Aus EP 1 279 385 A1 ist die Temperaturbestimmung bei der Behandlung von biologischem Gewebe insbesondere am Augenhintergrund mittels Laserstrahlung bekannt. Dabei werden während der jeweiligen Pulse der pulsförmigen Behandlungsstrahlung zusätzliche Strahlungspulse mit geringerer Pulsdauer und geringerer Energie als bei der Behandlungsstrahlung auf das Zielgewebe gerichtet. Dabei entstehende Gewebeexpansionen und Gewebekontraktionen erzeugen bipolare Druckwellen, welche detektiert werden. Aus diesen gemessenen Drucktransienten werden unter Zuhilfenahme der Grüneisen-Eichkurve und einer Eichtemperatur die entsprechenden Temperaturwerte während der Bestrahlung ermittelt.So far, the treatment parameters have been adjusted according to empirical values for the dosage. Due to different pigmentations in the eye, however, the temperatures generated during photocoagulation can fluctuate more or less strongly. EP 1 279 385 A1 discloses the temperature determination in the treatment of biological tissue, in particular on the ocular fundus, by means of laser radiation. During the respective pulses of the pulse-shaped treatment radiation, additional radiation pulses having a shorter pulse duration and lower energy than the treatment radiation are directed onto the target tissue. Resulting tissue expansions and tissue contractions produce bipolar pressure waves, which are detected. From these measured pressure transients, the corresponding temperature values during the irradiation are determined with the aid of the Grüneisen calibration curve and a calibration temperature.
Ferner ist es bekannt (DE 199 16 653 A1 ), die im Zielgewebe generierten Drucktransienten als Messgröße der optischen Eigenschaften des Zielgewebes heranzuziehen, um den weiteren Behandlungsverlauf durch Vergleich mit speziell ermittelten Kennlinien bezüglich des Verlaufs der Veränderungen der optischen Eigenschaften während der Therapie rechnergestützt und on-line vollautomatisiert zu steuern.Furthermore, it is known (DE 199 16 653 A1) to use the pressure transients generated in the target tissue as a measured variable of the optical properties of the target tissue in order to further computer-aided the further course of treatment by comparison with specially determined characteristics with respect to the course of the changes in the optical properties during therapy -line fully automated control.
Bei der Photokoagulation werden jedoch bei beginnender Denaturierung des Zielgewebes die Gewebeeigenschaften verändert, wodurch auch die durch die Messstrahlungen induzierten Druckamplituden beeinflusst werden.In photocoagulation, however, as the target tissue begins to denature, the tissue properties are altered, thereby also affecting the pressure amplitudes induced by the measurement radiations.
Aufgabe der Erfindung ist es, eine Vorrichtung der eingangsgenannten Art zu schaffen, bei welcher die Steuerung der Behandlungsstrahlung verbessert wird.The object of the invention is to provide a device of the type mentioned, in which the control of the treatment radiation is improved.
Diese Aufgabe wird erfindungsgemäß durch eine Vorrichtung mit den Merkmalen des Patenanspruches 1 gelöst. Die Unteransprüche beinhalten vorteilhafte Weiterbildungen der Erfindung.This object is achieved by a device with the features of claim 1. The subclaims contain advantageous developments of the invention.
Die Vorrichtung beinhaltet bei der Erfindung eine Einrichtung zur Erzeugung einer gepulsten, auf ein Zielgewebe zu richtenden Behandlungsstrahlung, vorzugsweise einer Laser- Strahlung. Ferner ist eine Detektoreinrichtung zur Erfassung von vom Zielgewebe ausgehenden Druckamplituden vorgesehen. Diese Druckamplituden können von der Behandlungsstrahlung induziert sein, wobei in diesem Fall die Behandlungsstrahlung eine Frequenz von mindestens 100 Hz aufweist. Ferner ist es möglich zusätzlich eine Messlasereinrichtung zur Erzeugung einer zusätzlichen gepulsten auf das Zielgewebe gerichteten Messstrahlung mit geringerer 'Energie und geringerer Pulsdauer als bei der Behandlungsstrahlung vorzusehen. In diesem Fall ist die Detektoreinrichtung zur Erfassung der von der Messstrahlung induzierten und vom Zielgewebe ausgehenden Druckamplituden geeignet. Femer ist eine Auswerteeinrichtung vorgesehen zum Auswerten der von der Detektoreinrichtung erfassten Druckamplituden und eine Steuereinrichtung zur Steuerung der Behandlungsstrahlung in Abhängigkeit von den ausgewerteten Druckamplituden.In the invention, the device includes a device for generating a pulsed treatment radiation, preferably a laser radiation, to be directed to a target tissue. Furthermore, a detector device is provided for detecting pressure amplitudes emanating from the target tissue. These pressure amplitudes may be induced by the treatment radiation, in which case the treatment radiation has a frequency of at least 100 Hz. Furthermore, it is possible to additionally provide a measuring laser device for generating an additional pulsed measuring radiation directed at the target tissue with lower energy and lower pulse duration than with the treatment radiation. In this case, the detector device is for detecting the pressure amplitudes induced by the measuring radiation and originating from the target tissue suitable. Furthermore, an evaluation device is provided for evaluating the pressure amplitudes detected by the detector device and a control device for controlling the treatment radiation as a function of the evaluated pressure amplitudes.
Bei der Behandlung des Zielgewebes mit der Behandlungsstrahlung insbesondere Laser- Strahlung, findet während eines ersten, aufheizenden Zeitintervalls At1 im Zielgewebe noch keine Gewebeänderung statt. Die Dauer dieses ersten Zeitintervalls kann beispielsweise 20 - 50 ms betragen.In the treatment of the target tissue with the treatment radiation, in particular laser radiation, no tissue change takes place during a first heating time interval At 1 in the target tissue. The duration of this first time interval may be, for example, 20-50 ms.
Während der Behandlung mit der Behandlungsstrahlung wird vorzugsweise mit zusätzlicher gepulster Laserstrahlung eingestrahlt, wie aus EP 1 279 385 A1 bekannt ist. Die sich dabei ergebenden Druckamplituden steigen mit der Zeit t während des Intervalls At1 im Mittel gemäß einer Funktion f(t) an.During the treatment with the treatment radiation is preferably irradiated with additional pulsed laser radiation, as is known from EP 1 279 385 A1. The resulting pressure amplitudes increase with time t during the interval At 1 on average according to a function f (t).
Die Funktion m(t) repräsentiert das grundsätzliche Krümmungsverhalten des zeitlichen Verlaufs der mittleren Druckamplituden während der Aufheizphase des Gewebes in Abwesenheit von Gewebeveränderungen. Die Funktion m(t) ist bekannt (Jochen Kandul- Ia, Ralf Brinkmann, „Nicht-invasive Echtzeit-Temperaturbestimmung während Laserbehandlungen an der Netzhaut des Auges": Photonic 2/2007, 42-46), ihr liegt die Errorfunk- tion zugrunde. Sie kann über kurze Zeitintervalle mit verschiedenen einfacheren Funktionen gut approximiert werden. Die Funktion m(t) kann in einem Speicher der Auswerteeinrichtung oder einem Speicher, welcher mit der Auswerteeinrichtung verbunden ist, ge- speichert werden.The function m (t) represents the fundamental curvature behavior of the time course of the mean pressure amplitudes during the heating phase of the tissue in the absence of tissue changes. The function m (t) is known (Jochen Kandul-Ia, Ralf Brinkmann, "Non-invasive real-time temperature determination during laser treatments on the retina of the eye": Photonic 2/2007, 42-46), which is based on the error function It can be well approximated over short time intervals with various simpler functions The function m (t) can be stored in a memory of the evaluation device or a memory which is connected to the evaluation device.
Der Fitfaktor a gemäß der Gleichung f(t)=a*m(t) ist vor der Messung unbekannt und insbesondere für jeden Bestrahlungsort in der Regel anders. Der Fitfaktor a hängt ab von der Probelaserenergie und Pigmentierung des gerade bestrahlten Areals, ebenso aber auch von der Schallausbreitung im Auge, dem akustischen Impedanzsprung an der Hornhaut, der Schallwandlergeometrie und -empfindlichkeit, der Signalverstärkung etc.The fit factor a according to the equation f (t) = a * m (t) is unknown prior to the measurement and, in particular, different for each irradiation location. The fit factor a depends on the sample laser energy and pigmentation of the area just irradiated, but also on the sound propagation in the eye, the acoustic impedance jump on the cornea, the transducer geometry and sensitivity, the signal amplification, etc.
An jedem Bestrahlungsort wird der gemittelte Verlauf f(t) der im Zeitintervall At1 gemessenen Druckamplituden mit dem sich dabei ergebenden Fitfaktor a gemäß der Fitbedingung f(t) = a*m(t) angefittet. Damit steht eine Funktion a*m(t) auch in einem dem ersten Zeitintervall nachfolgenden Zeitbereich At2 zur Verfügung.At each irradiation location, the averaged profile f (t) of the pressure amplitudes measured in the time interval At 1 is fitted with the resulting fit factor a according to the fit condition f (t) = a * m (t). Thus, a function a * m (t) is also available in a time interval At 2 following the first time interval.
In At2 wird zu jedem Zeitpunkt t das Verhältnis von aktueller Messdatenfunktion f(t), die den gemittelten Verlauf der gemessenen Druckamplituden wiedergibt, und der Funktion a*m(t) gebildet Aufgrund des Rauschens der Messdaten kann in vorteilhafter Weise zu jedem Zeitpunkt ein Mittelwert der aktuellen Messwerte f(t) (z B aus 10 Messwerten) mit der Funktion a*m(t) ins Verhältnis gesetzt werden, etwa als V(t) = f(t)/[a*m(t)]In At 2 , the ratio of current measurement data function f (t), which represents the averaged course of the measured pressure amplitudes, and the function is at any time t Due to the noise of the measured data, an average value of the current measured values f (t) (z B from 10 measured values) can advantageously be compared with the function a * m (t) at any time, for example as V (t) = f (t) / [a * m (t)]
Für eine Gewebeanderung insbesondere Gewebekoagulation ist die Auswerteeinrichtung so ausgebildet, dass sie feststellt, ob und wann in dem dem ersten Zeitmtervall folgenden zweiten Zeitmtervall Δt2 eine bestimmte vorher festgelegte Abweichung V* der aktuellenFor a tissue change, in particular tissue coagulation, the evaluation device is designed such that it determines whether and when in the second time interval Δt 2 following the first time interval a certain predetermined deviation V * of the current one
Messwerte f(t) von der Funktion auftritt (z B 20%, d h z B V*=0 8) Das Feststellen einer derart signifikanten Abweichung wahrend des Zeitintervalls At2 markiert erfindungs- gemaß, dass Gewebeveranderungen kurz zuvor eingesetzt haben Jedes Fortsetzen der bisherigen Bestrahlung wurde sicher einen noch stärkeren Gewebeschaden erzeugenMeasurements f (t) of the function occurs (eg, 20%, ie BV * = 0 8) The detection of such a significant deviation during the time interval At 2 marks according to the invention that tissue changes have recently begun Each resumption of the previous irradiation has certainly produce even more tissue damage
Aus dem Zeitpunkt t„ zu dem die festgelegte Abweichung V* auftritt (also V(t,)=V*), ist insbesondere die Abiaufgeschwindigkeit der Gewebedenatuπerung bei fortgesetzter Bestrahlung abschatzbar Aus dem Zeitpunkt t, werden die Bestrahlungsparameter der Behandlungsstrahlung für das dritte sich an das zweite Zeltintervall anschließende Zeit- Intervall Δt3 festgelegt Diese ergeben sich aus zuvor experimentell gewonnenen Daten Die experimentell ermittelten Daten können in einem Speicher der Auswerteeinrichtung oder in einem an die Auswerteeinπchtung angeschlossenen Speicher gespeichert seinFrom the time t "at which the predetermined deviation V * occurs (ie V (t,) = V * ), in particular the Abiaufgeschwindigkeit the Gewebedenatuπerung with continued irradiation is estimated From the time t, the irradiation parameters of the treatment radiation for the third to The second tent interval subsequent time interval .DELTA.t 3 determined This results from previously experimentally obtained data The experimentally determined data can be stored in a memory of the evaluation or in a memory connected to the Auswerteeinπchtung
Die Steuerschaltung, welche zur Steuerung der Behandlungsstrahlung dient, kann zur Steuerung der Dauer und/oder der Leistung des jeweiligen Pulses der Behandlungsstrah- lung ausgebildet sein Bei gleichbleibender Strahlungsleistung bestimmt sich die Dauer von Δt3 vom Zeitpunkt t, bzw von der Dauer von Δt2, wobei z B die Dauer von Δt3 proportional zur Dauer von Δt2 gewählt werden kann Je kurzer Δt2 ist, umso kurzer ist Δt3 The control circuit, which serves to control the treatment radiation, can be designed to control the duration and / or the power of the respective pulse of the treatment radiation. With constant radiation power, the duration of Δt 3 is determined by the time t, or by the duration of Δt 2 , where z B the duration of Δt 3 can be selected in proportion to the duration of At 2 The shorter Δt 2 , the shorter is Δt 3
Die Auswerteeinrichtung ist vorzugsweise als rechnergestutzte Auswerteeinrichtung ausgebildet, welche entsprechende Speicher für die Funktion m(t) und die für die Steue- rung der Behandlungsstrahlung, insbesondere im dritten Zeitintervall erforderlichen experimentell ermittelten Daten enthalt Hier kann es sich um Daten bezüglich der noch anzuwendenden Bearbeitungszeit und/oder der anzuwendenden Leistung der Behandlungsstrahlung handeln Durch die Erfindung wird es ermöglicht, die gemessenen Druck- transienten für die Steuerung der Behandlungsstrahlung zu verwenden Insbesondere ist keine Kalibrierung oder Eichung auf eine Temperatur oder andere Referenzwerte notigThe evaluation device is preferably designed as a computer-aided evaluation device which contains corresponding memories for the function m (t) and the experimentally determined data required for the control of the treatment radiation, in particular in the third time interval. This may be data relating to the still-to-be-processed time and The invention makes it possible to use the measured pressure transients for the control of the treatment radiation. In particular, no calibration or calibration to a temperature or other reference values is necessary
Anhand der Figuren wird die Erfindung noch naher erläutert Es zeigt:With reference to the figures, the invention will be explained in more detail It shows:
Figur 1 ein Ausführungsbeispiel der erfindungsgemäßen Vorrichtung; undFigure 1 shows an embodiment of the device according to the invention; and
Figur 2 eine Kurvendarstellung zur Erläuterung der Funktionsweise des in Figur 1 dargestellten Ausführungsbeispiels;Figure 2 is a graph illustrating the operation of the embodiment shown in Figure 1;
Die Figur 1 zeigt als schematisches Blockschaltbild ein Ausführungsbeispiel der Behandlungsvorrichtung. Diese beinhaltet eine Behandlungslasereinrichtung 1 welche einen Behandlungslaser aufweist, der im grünen Wellenlängenbereich, beispielsweise mit einer Wellenlänge von 532 nm eine gepulste Behandlungsstrahlung aussendet. Hierfür kann beispielsweise ein frequenzverdoppelter Nd: YAG-Laser verwendet werden. Es eignet sich auch ein Argon-Ionen-Laser, der gepulste Behandlungsstrahlung mit einer Wellenlänge von 514 nm aussendet. Die Spotgrößen für den auf das Zielgewebe auftreffenden Behandlungsstrahl können von 10 μm bis 1000 μm betragen. Die Bestrahlungszeiten für jeden Strahlungspuls können von 30 ms bis 500 ms oder auch darüber betragen. Die Laserleistung wird je nach der durchzuführenden Behandlung von 30 mW bis über 1000 mW ausgewählt werden.1 shows a schematic block diagram of an embodiment of the treatment device. This includes a treatment laser device 1 which has a treatment laser which emits a pulsed treatment radiation in the green wavelength range, for example with a wavelength of 532 nm. For this example, a frequency doubled Nd: YAG laser can be used. An argon-ion laser emitting pulsed treatment radiation with a wavelength of 514 nm is also suitable. The spot sizes for the treatment beam impinging on the target tissue may be from 10 μm to 1000 μm. The irradiation times for each radiation pulse may be from 30 ms to 500 ms or even higher. The laser power will be selected from 30 mW to over 1000 mW, depending on the treatment to be performed.
Die dargestellte Vorrichtung beinhaltet ferner zwei Messlasereinrichtungen 2 und 3. Die Messlasereinrichtung 2 beinhaltet einen Messlaser, welcher im grünen Wellenlängenbereich beispielsweise mit einer Wellenlänge 532 nm eine gepulste Messlaserstrahlung aussendet. Diese Messlaserstrahlung wird mittels eines Optikkopplers 7 in den Strahlen- gang der Behandlungslaser-Strahlung eingekoppelt. Die zweite Messlasereinrichtung 3 beinhaltet einen Messlaser, der im Infrarotbereich beispielsweise mit einer Wellenlänge von 1064 nm gepulste Messstrahlung aussendet. Die Messstrahlung wird mittels eines Optikkopplers 8 in den Strahlengang der Behandlungsstrahlung eingekoppelt. Die Pulsenergie der beiden Messlaser ist bedeutend geringer als die der Behandlungsstrahlung und beträgt typischerweise wenige μJ. Die Pulsdauern sind ebenfalls um das mindestens hundertfache geringer als die der Behandlungsstrahlung.The illustrated apparatus further includes two measuring laser devices 2 and 3. The measuring laser device 2 includes a measuring laser which emits pulsed measuring laser radiation in the green wavelength range, for example with a wavelength of 532 nm. This measurement laser radiation is coupled into the beam path of the treatment laser radiation by means of an optical coupler 7. The second measuring laser device 3 includes a measuring laser which emits pulsed measuring radiation in the infrared range, for example with a wavelength of 1064 nm. The measuring radiation is coupled by means of an optical coupler 8 in the beam path of the treatment radiation. The pulse energy of the two measuring lasers is significantly lower than that of the treatment radiation and is typically a few μJ. The pulse durations are also at least a hundred times lower than the treatment radiation.
Wie oben schon erläutert, werden in den aus einem Lichtleiter 10 von der Behandlungslasereinrichtung 1 kommenden Behandlungsstrahlengang mittel der Optikkoppler 7 und 8 die beiden Messstrahlungen der Messlasereinrichtungen 2 und 3 eingekoppelt. Die Behandlungsstrahlung und die Messstrahlungen werden über einen gemeinsamen Lichtleiter 10 in eine Spaltlampenoptik 9 geleitet und von dort auf den Augenhintergrund, beispielsweise die Retina eines Auges 11 , gerichtet. Auf diese Weise wird erreicht, dass die Behandlungsstrahlung und die beiden Messstrahlungen im gleichen Spot auf das Zielgewebe der Retina auftreffen. Es ist jedoch auch möglich, völlig getrennte Strahlengänge und entsprechend unterschiedliche Spotdurchmesser im Auge zu verwenden.As already explained above, the two measuring radiations of the measuring laser devices 2 and 3 are coupled into the treatment beam path coming from a light guide 10 from the treatment laser device 1 by means of the optical couplers 7 and 8. The treatment radiation and the measurement radiation are conducted via a common light guide 10 into a slit lamp optics 9 and directed from there to the fundus, for example the retina of an eye 11. In this way it is achieved that the treatment radiation and the two measuring radiation impinge on the target tissue of the retina in the same spot. However, it is also possible to use completely separate beam paths and correspondingly different spot diameters in the eye.
Die von den beiden Messstrahlungen induzierten Druckwellen werden von einem Detek- tor 4 erfasst und gemessen. Der Detektor 4 wird mittels eines Kontaktglases auf die Augenhornhaut aufgesetzt. In EP 1 279 385 A1 sind verschiedene Detektoranordnungen beschrieben, welche verwendet werden können.The pressure waves induced by the two measuring radiations are detected and measured by a detector 4. The detector 4 is placed on the cornea by means of a contact lens. EP 1 279 385 A1 describes various detector arrangements which can be used.
Anstelle von zwei Messlasereinrichtungen kann auch nur eine Messlasereinrichtung verwendet werden. Es ist auch möglich mehr als zwei Messlasereinrichtungen zum Einsatz zu bringen.Instead of two measuring laser devices, only one measuring laser device can be used. It is also possible to use more than two measuring laser devices.
Es ist auch möglich ohne Messlasereinrichtungen, das heißt nur mit der Behandlungslastereinrichtung 1 zu arbeiten. Hierbei wird die Frequenz der Behandlungsstrahlung so gewählt, dass auswertbare Druckamplituden von der Detektoreinrichtung 4 erfasst werden. Die Frequenz der Behandlungsstrahlung beträgt in diesem Fall mindestens 100 Hz. Die von dieser Strahlung am Zielgewebe induzierten Druckamplituden werden dann von der Detektoreinrichtung 4 für die Auswertung erfasst.It is also possible without measuring laser devices, that is to work only with the treatment load device 1. Here, the frequency of the treatment radiation is chosen so that evaluable pressure amplitudes are detected by the detector device 4. The frequency of the treatment radiation in this case is at least 100 Hz. The pressure amplitudes induced by this radiation on the target tissue are then detected by the detector device 4 for the evaluation.
Die von der Detektoreinrichtung 4 gemessenen Druckamplituden (Drucktransienten) werden einer Auswerteeinrichtung 5 zugeleitet und, wie noch erläutert wird, ausgewertet. In Abhängigkeit von der Auswertung erfolgt dann mittels einer Steuereinrichtung 6 die Steuerung der Behandlungslasereinrichtung, insbesondere des Behandlungslasers.The pressure amplitudes (pressure transients) measured by the detector device 4 are fed to an evaluation device 5 and, as will be explained, evaluated. Depending on the evaluation, the control of the treatment laser device, in particular of the treatment laser, then takes place by means of a control device 6.
Sowohl die Auswerteeinrichtung 5 als auch die Steuereinrichtung 6 arbeiten rechnergestützt und können in einer elektronischen Rechnereinrichtung 15 implementiert sein.Both the evaluation device 5 and the control device 6 work computer-aided and can be implemented in an electronic computer device 15.
In Figur 2 sind die Verläufe der von den beiden Messstrahlungen induzierten Druckamplituden über die Zeit t in Sekunden (s) aufgetragen. Sowohl für die im grünen Wellenlän- genbereich induzierten Drucktransienten als auch für die im infraroten Wellenlängenbereich induzierten Drucktransienten ergibt sich bei konstanter Pulsenergie des jeweiligen Messlasers bzw. des Behandlungslasers ein Ansteigen der Druckamplituden aufgrund der Temperaturabhängigkeit der thermoelastischen Expansion. Bei Verwendung einer Behandlungslaserleistung, welche eine Gewebekoagulation auslöst, beispielsweise einer Laserleistung von 180 mW, erfolgt innerhalb eines ersten Zeitintervalls At1, in welchem noch keine Photokoagulation stattfindet, ein im wesentlichen identischer Druckanstieg bei beiden induzierten Drucktransienten 13 und 14. Die Drucktransienten 13 sind die grün induzierten Drucktransienten und die Drucktransienten 14 sind die infrarot induzierten Drucktransienten.In FIG. 2, the curves of the pressure amplitudes induced by the two measuring radiations are plotted over the time t in seconds (s). Both for the pressure transients induced in the green wavelength range and for the pressure transients induced in the infrared wavelength range, an increase in the pressure amplitudes due to the temperature dependence of the thermoelastic expansion results at constant pulse energy of the respective measuring laser or treatment laser. When using a treatment laser power which triggers a tissue coagulation, for example a laser power of 180 mW, a substantially identical increase in pressure occurs within a first time interval At 1 in which no photocoagulation takes place both induced pressure transients 13 and 14. The pressure transients 13 are the green induced pressure transients and the pressure transients 14 are the infrared induced pressure transients.
Bei beginnender Koagulation zeigt der Verlauf der grün induzierten Druckamplituden eine Abflachung, während die infrarot induzierten Druckamplituden weiter steigen. Der unterschiedliche Verlauf der beiden Druckkurven ergibt sich daraus, dass die infrarote Messstrahlung tiefer in die Fundusschicht eindringt als die grüne Messstrahlung. Für den grünen, stark im RPE absorbierten Strahl erhöht sich die Streuung mit einsetzender Koagulation in der Retina und dem RPE, was die Absorption im Zielgewebe reduziert. Im Infraroten tritt dieser Effekt auch auf, ist jedoch schwächer aufgrund der höheren Wellenlänge. Er wird jedoch überkompensiert durch die insgesamt erhöhte Absorption in der Choroidea durch die reduzierte mittlere freie Weglänge eines Photons. Die beginnende Photokoagulation des Gewebes führt zu Druckänderungen und Abweichungen vom erwarteten Druckverlauf ohne Phasenübergang. Dieses Verhalten wird erfindungsgemäß ausgenutzt, indem an den aktuell gemessenen Druckverlauf der Messdaten während des ersten Zeitintervalls Δti eine Funktion a*m(t) mit einem möglichst einfachen Algorithmus angefittet wird. Die Kurve 12 stellt diese Funktion, welche zur Steuerung der Behandlungsstrahlung mit verwendet wird, dar. Das erste Zeitintervall At1 wird so klein gewählt, dass mit Bestimmtheit keine Veränderungen des bestrahlten Gewebes eintreten. Dieses Zeitintervall kann beispielsweise 20-50 ms betragen.At the beginning of coagulation, the course of the green-induced pressure amplitudes shows a flattening, while the infrared-induced pressure amplitudes continue to increase. The different course of the two pressure curves results from the fact that the infrared measuring radiation penetrates deeper into the fundus layer than the green measuring radiation. For the green beam strongly absorbed in the RPE, the scattering increases with onset of coagulation in the retina and the RPE, which reduces absorption in the target tissue. In the infrared, this effect also occurs, but is weaker due to the higher wavelength. However, it is overcompensated by the overall increased absorption in the choroid by the reduced mean free path of a photon. The incipient photocoagulation of the tissue leads to pressure changes and deviations from the expected pressure curve without phase transition. This behavior is exploited according to the invention by fitting a function a * m (t) with the simplest possible algorithm to the currently measured pressure profile of the measured data during the first time interval Δti. Curve 12 represents this function, which is used to control the treatment radiation. The first time interval At 1 is chosen to be so small that it is certain that no changes in the irradiated tissue occur. This time interval may be, for example, 20-50 ms.
Der gemittelte Verlauf f(t) der Messdaten für die von der Messlaserstrahlung im ersten Zeitintervall At1 induzierten Drucktransienten wird mit einem möglichst einfachen Algorithmus, gemäß der Fitbedingung f(t) = a*m (t) angefittet. Es können natürlich auch komplexe Abbildungsalgorithmen eingesetzt werden. Der Verlauf der aktuellen Messdaten- Funktion f(t)und von a*m(t) werden während der Behandlungsstrahlung an einem jeweiligen Zielgewebe ermittelt.The averaged trace f (t) of the measured data for the pressure transient induced by the measuring laser radiation in the first time interval At 1 is fitted with the simplest possible algorithm, in accordance with the fit condition f (t) = a * m (t). Of course, complex imaging algorithms can also be used. The course of the current measurement data function f (t) and of a * m (t) are determined during the treatment radiation on a respective target tissue.
In dem sich an das erste Zeitintervall anschließenden zweiten Zeitintervall Δt2 wird zu jedem Zeitpunkt das Verhältnis V aus dem mittleren Messwert f(t) für die beispielsweise grün induzierten Drucktransienten zur Funktion a*m(t), welche in der Figur 2 mit dem Bezugszeichen 12 bezeichnet ist, gebildet. Weicht das Verhältnis V zu einem Zeitpunkt t, um mehr als einen vorbestimmten Verhältniswert, beispielsweise 20 % (0,2), von V=1 ab, wird das zweite Zeitintervall Δt2 beendet. Im dritten Zeitintervall Δt3, welches zum Zeitpunkt t, beginnt, kann auf tabellierte Daten zurückgegriffen werden, die experimentell zuvor ermittelt wurden. Es handelt sich hierbei insbesondere um Daten zur Berechnung der Dauer des dritten Zeitintervalls Δt3 und gegebenenfalls um Daten zur Veränderung der Leistung der Behandlungsstrahlung für eine vorgewählte Koagulationsstärke.In the second time interval Δt 2 , which adjoins the first time interval, the ratio V from the mean measured value f (t) for the, for example, green-induced pressure transients to the function a * m (t), which in FIG 12 is formed formed. If the ratio V deviates from V = 1 by more than a predetermined ratio value, for example 20% (0.2), at a time t, the second time interval Δt 2 is ended. In the third time interval Δt 3 , which begins at the time t, it is possible to resort to tabulated data which have been previously determined experimentally. These are, in particular, data for calculating the duration of the third time interval Δt 3 and, if appropriate, data for changing the power of the treatment radiation for a preselected coagulation intensity.
Bei z. B. gleichbleibender Leistung der Behandlungsstrahlung wird die Dauer der Bestrahlung im dritten Zeitintervall proportional zur Dauer des zweiten Zeitintervalls Δt2 bzw. proportional zum Zeitpunkt t| gewählt.At z. B. constant power of the treatment radiation, the duration of the irradiation in the third time interval is proportional to the duration of the second time interval .DELTA.t 2 or proportional to the time t selected.
Die in der Fitbedingung benutzte Funktion m(t) kann im Speicher des Rechners 15 abge- legt werden. Der Funktion m(t) liegt zugrunde, dass der Anstieg der Druckamplitude als Funktion der Temperatur am Bestrahlungsort in guter Nährung mit einem Polynom zweiten Grades beschreibbar ist. Die zeitliche Entwicklung der Temperaturerhöhung als Folge der Behandlungsbestrahlung ergibt sich wiederum theoretisch aus der Errorfunktion als Lösung der Wärmediffusionsgleichung. (Jochen Kandulla, Ralf Brinkmann, „Nicht- invasive Echtzeit-Temperaturbestimmung während Laserbehandlungen an der Netzhaut des Auges": Photonic 2/2007, 42-46). The function m (t) used in the fit condition can be stored in the memory of the computer 15. The function m (t) is based on the fact that the increase in the pressure amplitude as a function of the temperature at the irradiation location can be described in good nutrition with a second-degree polynomial. The temporal development of the temperature increase as a result of the treatment irradiation is again theoretically derived from the error function as a solution of the heat diffusion equation. (Jochen Kandulla, Ralf Brinkmann, "Non-invasive real-time temperature determination during laser treatment of the retina of the eye": Photonic 2/2007, 42-46).
Bezugszeichenliste:LIST OF REFERENCE NUMBERS
1 Behandlungslasereinrichtung1 treatment laser device
2 Messlasereinrichtung2 measuring laser device
3 Messlasereinrichtung3 measuring laser device
4 Detektoreinrichtung4 detector device
5 Auswerteeinrichtung5 evaluation device
6 Steuereinrichtung6 control device
7 Koppleroptik7 coupler optics
8 Koppleroptik8 coupler optics
9 Spaltlampengerät9 slit lamp device
10 Lichtleiter10 light guides
11 Auge11 eye
12 Fitfunktion12 Fit function
13 Grün-induzierte Drucktransienten13 green-induced pressure transients
14 Infrarot-induzierte Drucktransienten14 infrared-induced pressure transients
15 Elektronische Rechnereinrichtung 15 Electronic computer device

Claims

Patentansprüche claims
1. Vorrichtung zur Behandlung von biologischem, insbesondere lebendem Gewebe mit1. A device for the treatment of biological, in particular living tissue with
- einer Behandlungseinrichtung (1 ) zur Erzeugung einer gepulsten auf ein- A treatment device (1) for generating a pulsed on a
Zielgewebe zu richtenden Behandlungsstrahlung,Target tissue to be treated treatment radiation,
einer Detektoreinrichtung (4) zur Erfassung von vom Zielgewebe ausgehenden Druckamplituden (Drucktransienten),a detector device (4) for detecting pressure amplitudes emanating from the target tissue (pressure transients),
einer Auswerteeinrichtung (5) zum Auswerten der von der Detektoreinrich- tung (4) erfassten Druckamplituden, undan evaluation device (5) for evaluating the pressure amplitudes detected by the detector device (4), and
einer Steuereinrichtung (6) zur Steuerung der Behandlungsstrahlung in Abhängigkeit von den ausgewerteten Druckamplituden,a control device (6) for controlling the treatment radiation as a function of the evaluated pressure amplitudes,
dadurch gekennzeichnet, dasscharacterized in that
die Auswerteeinrichtung (5) ausgebildet ist, für eine Gewebeänderung, ins- besondere Gewebekoagulation, in einem zweiten Zeitintervall Δt2, welches einem ersten Zeitintervall At1, bei dem keine Gewebeänderung am Zielgewebe stattfindet, folgt, eine Abweichung eines gemittelten Verlaufs f(t) der innerhalb des zweiten Zeitintervalls Δt2 gemessenen Druckamplituden von einer Funktion a*m(t), zu bestimmen,the evaluation device (5) is designed, for a tissue change, in particular tissue coagulation, in a second time interval Δt 2 , which follows a first time interval At 1 , in which no tissue change takes place on the target tissue, a deviation of an averaged course f (t) the pressure amplitudes of a function a * m (t) measured within the second time interval Δt 2 ,
- wobei m(t) ein vorab bekanntes Krümmungsverhalten des gemittelten zeitlichen Verlaufs f(t) der während des ersten Zeitintervalls At1 gemessenen Druckamplituden repräsentiert und a aus der Fitbedingung f(t) = a*m(t) einer Fitprozedur am Ende von At1 bestimmt wird,where m (t) represents a previously known curvature behavior of the averaged time curve f (t) of the pressure amplitudes measured during the first time interval At 1 and a from the fit condition f (t) = a * m (t) of a fit procedure at the end of At 1 is determined
einen Zeitpunkt ti zu bestimmen, an welchem die Abweichung einen be- stimmten Wert erreicht, und in Abhängigkeit vom bestimmten Zeitpunkt ti für ein drittes, sich an das zweite Zeitintervall Δt2 anschließendes Zeitintervall Δt3 Behandlungsstrahlungs- parameter vorzugeben.to determine a time ti at which the deviation reaches a certain value, and predetermine, depending on the specific point in time ti for a third, is then at the second time interval At 2 time interval At 3 Behandlungsstrahlungs- parameter.
2. Vorrichtung nach Anspruch 1 , dadurch gekennzeichnet, dass die Steuerschaltung (6) ausgebildet ist zur Steuerung der Dauer und/oder der Leistung des jeweiligen2. Device according to claim 1, characterized in that the control circuit (6) is designed to control the duration and / or the power of the respective
Pulses der Behandlungsstrahlung.Pulse of treatment radiation.
3. Vorrichtung nach einem der Ansprüche 1 bis 3, dadurch gekennzeichnet, dass die Auswerteeinrichtung (5) einen Speicher aufweist oder an einen Speicher angeschlossen ist, in welchem der Krümmungsverlauf m(t) der Funktion f(t) gespeichert ist.3. Device according to one of claims 1 to 3, characterized in that the evaluation device (5) has a memory or is connected to a memory in which the curvature m (t) of the function f (t) is stored.
4. Vorrichtung nach einem der Ansprüche 1 bis 3, dadurch gekennzeichnet, dass die Auswerteeinrichtung (5) einen Speicher aufweist oder an einen Speicher angeschlossen ist, in welchem experimentell ermittelte Daten für die Vorgabe der Behandlungsparameter im dritten Zeitintervall Δt3 gespeichert sind.4. Device according to one of claims 1 to 3, characterized in that the evaluation device (5) has a memory or is connected to a memory in which experimentally determined data for the specification of the treatment parameters in the third time interval .DELTA.t 3 are stored.
5. Vorrichtung nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, dass bei gleichbleibender Leistung der Behandlungsstrahlung die Behandlungsdauer im dritten Zeitintervall Δt3 proportional zur Dauer des zweiten Zeitintervalls Δt2 ist.5. Device according to one of claims 1 to 4, characterized in that at constant power of the treatment radiation, the treatment time in the third time interval .DELTA.t 3 is proportional to the duration of the second time interval .DELTA.t 2 .
6. Vorrichtung nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, dass zusätzlich zur Behandlungseinrichtung (1 ) eine Messlasereinrichtung (2, 3) zur Er- zeugung einer zusätzlichen gepulsten, auf das Zielgewebe gerichteten Messstrahlung mit geringerer Energie und geringerer Pulsdauer als bei der Behandlungsstrahlung vorgesehen ist und die Detektoreinrichtung (4) zur Erfassung der durch die Messstrahlung induzierten und vom Zielgewebe ausgehenden Druckamplituden ausgebildet ist.6. Device according to one of claims 1 to 5, characterized in that in addition to the treatment device (1) a measuring laser device (2, 3) for generating an additional pulsed, directed to the target tissue measuring radiation with lower energy and lower pulse duration than in the Treatment radiation is provided and the detector device (4) is designed to detect the induced by the measuring radiation and emanating from the target tissue pressure amplitudes.
7. Vorrichtung nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, dass die Detektoreinrichtung (4) zur Erfassung der von der Behandlungsstrahlung induzierten und vom Zielgewebe ausgehenden Druckamplituden ausgebildet ist.7. Device according to one of claims 1 to 5, characterized in that the detector device (4) is designed to detect the radiation induced by the treatment and emanating from the target tissue pressure amplitudes.
8. Vorrichtung nach Anspruch 7, dass die Frequenz der Behandlungsstrahlung mindestens 100 Hz beträgt. 8. Apparatus according to claim 7, that the frequency of the treatment radiation is at least 100 Hz.
9. Vorrichtung nach einem der Ansprüche 1 bis 8, gekennzeichnet durch ihre Ausbildung zur Durchführung einer Photokoagulation am Fundus eines Auges, insbesondere am RPE. 9. Device according to one of claims 1 to 8, characterized by its design for carrying out a photocoagulation on the fundus of an eye, in particular on the RPE.
EP09778438A 2008-09-09 2009-09-09 Device for the treatment of biological tissue using laser radiation Active EP2337532B1 (en)

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DE102008046394 2008-09-09
PCT/EP2009/006552 WO2010028822A1 (en) 2008-09-09 2009-09-09 Device for the treatment of biological tissue using laser radiation

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US8465477B2 (en) * 2009-12-07 2013-06-18 Wavelight Ag Apparatus for laser surgical ophthalmology
US11554047B2 (en) * 2017-07-21 2023-01-17 Lutronic Vision Inc. Radiation dosimetry systems and methods
WO2019100248A1 (en) 2017-11-22 2019-05-31 Xinova, LLC Optical filter on contact lens surface
EP4046684B1 (en) * 2021-02-23 2023-08-23 Medizinisches Laserzentrum Lübeck GmbH Biological tissue treatment apparatus

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DE19916653A1 (en) 1999-04-14 2000-10-19 Holger Lubatschowski Laser cyclo-photocoagulation for treatment of the cilary body in cases on intractable glaucoma uses opto-acoustic tissue differentiation so that tissue type is more accurately determined and an appropriate dose applied
GB0015250D0 (en) 2000-06-22 2000-08-16 Payne Peter A Ophthalmic uses of lasers
DE10135944C2 (en) * 2001-07-24 2003-10-02 Med Laserzentrum Luebeck Gmbh Method and device for the non-invasive determination of the temperature on biological tissue treated with radiation, in particular laser radiation
US6832567B2 (en) * 2002-12-10 2004-12-21 Gary W. Clem, Inc. Method and apparatus for planting seed in a seed research plot
DE10331792A1 (en) * 2003-07-11 2005-02-17 Medizinisches Laserzentrum Lübeck GmbH Laser with dose rate control

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WO2010028822A1 (en) 2010-03-18
US20110184393A1 (en) 2011-07-28
US8480660B2 (en) 2013-07-09
JP5202739B2 (en) 2013-06-05
JP2012501769A (en) 2012-01-26

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